Overcoming Depression For Dummies
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The more items you ticked in the ‘Depression and Relationships Quiz’, the more likely it is that depression is affecting your relationships. For more information about how depression can impact upon your relationships and what you can do about it, see Part IV.
Feeling foul: The physical signs of depression
Depression usually shows some physical symptoms. They include changes in appetite, sleep, and energy. However, for some people, the experience of depression primarily consists of these physical symptoms and doesn’t noticeably affect mood and relationships.
If you experience depression primarily in physical terms you may be unaware of your emotional life. This could be because you were brought up to hide your feelings or your parents told you off for crying or showing other feelings such as excitement or sadness.
When Carl was growing up, his father got angry with him for crying. He said that big boys are tough and that Carl should never show weakness. His father also told him off for getting too excited about Christmas. He said men don’t show emotion. Over time, Carl got the knack of keeping his feelings to himself.
After five years of marriage, Carl’s wife leaves him; she says that he’s an unfeeling and uncaring man. Over the next six months, Carl finds he’s lost his appetite, and when he does eat, food just doesn’t taste as good as before. His energy drains away. He starts to have headaches and frequent bouts of constipation, and his blood pressure rises.
When he goes to the doctor’s surgery, his GP asks, ‘Look, Carl, your wife left you just six months ago. Are you sure you aren’t depressed?’ Carl answers, ‘Are you kidding? Depression’s something women get! No way can I be depressed!’ Nonetheless, after detailed examination, his doctor decides that depression is indeed causing Carl’s physical problems. Nothing else fits the pattern.
Are you experiencing certain changes in your body you can’t explain? The following ‘Depression in the Body Quiz’ highlights some of the ways that depression can show itself within your body. You know what to do – tick each item that applies to you.
My blood pressure has risen lately for no obvious reason.
I have no appetite these days.
I haven’t been sleeping nearly as well as usual.
My diet is the same, but I’m having frequent constipation for no reason.
I often feel nauseous.
I suffer from loads of aches and pains.
I’m sleeping much more than usual.
I’m always hungry, and for no reason.
My energy has been very low lately.
I’ve gained (or lost) more than 2 kilograms (about 4.5 pounds), and I can’t work out why.
Like the other three quizzes in this chapter, it really doesn’t matter exactly how many of the items apply to you. However, be aware that the more items you tick, the greater the chance that you are suffering from depression.
If your depression shows itself in physical symptoms, medication or some other physical remedy is likely to be the best choice for you. See Part V for more information on physical remedies.
The experiences listed in the quizzes may be caused by other health-related problems, not just depression. Therefore, if you’re having any worrying physical problems, see your doctor, especially if the symptoms last for more than a week or two.
Examining the Six Types of Depression
In ‘Recognising the Damage of Depression’, earlier in this chapter, we outline the four broad ways in which all types of depression can affect an individual. In this section, we turn our attention to the six major types of depression to look out for:
Major depressive disorder
Dysthymic disorder
Adjustment disorder with depressed mood
Bipolar disorder
Seasonal affective disorder
Depression related to hormones
There are two classification systems in use for describing mental disorders. We have already mentioned the ICD-10. The other is the American system known as the DSM-IV, or Diagnostic and Statistical Manual, version IV. In the following sections, we describe the six major types of depression and their symptoms based on information in DSM-IV.
Diagnosing clinical depression
Clinical depression is a medical term, and goes beyond the common experience of just feeling sad or low.. To decide whether someone is suffering from a clinical episode of depression, doctors use the diagnostic criteria set out in ICD-10 (the tenth edition of the International Classification of Diseases, published by the World Health Organization). ICD-10 describes and categorises mental disorders to help doctors identify the symptoms necessary to make a diagnosis. It is the classification system normally used by doctors in the U.K.
According to the ICD-10 criteria, a diagnosis of depressive episode means that a person has experienced at least two out of the following three core symptoms for most of the day, nearly every day for a minimum of two weeks:
Anhedonia: Lack of interest or enjoyment in things
Fatigue: Feeling tired or having little energy
Low mood: Feeling low, unhappy, sad or miserable
Recognising the different types of depression can help you work out if you’re suffering from depression. But don’t go so far as to give yourself a formal diagnosis; that’s the job for the professionals.
If you feel that you have significant signs of any of the six types of depression we list, get help. You can start with the advice in this book, but if you don’t feel much better within two months, see your doctor or a mental health professional. Seek help even sooner if your depression includes serious thoughts of suicide or hopelessness.
Major depressive disorder: Can’t even get out of bed
As with all types of depression, the symptoms of a major depressive disorder occur within the four areas – thought, behaviour, relationships, and the body – described earlier in the chapter in ‘Recognising the Damage of Depression’. So what’s unique about a major depressive disorder?
Major depressive disorders include a seriously low mood or a notable drop in pleasures and interests lasting for two weeks or more. Sometimes depressed people deny these low feelings and any loss of interest – on purpose, or without being aware of it. However, despite the denial people who know the depressed person well can usually spot the difference.
As well as low mood and lack of pleasure, to qualify as experiencing a major depressive disorder, you usually have a wide variety of other symptoms, such as:
Clear signs of increased agitation or slowed functioning
Extreme fatigue
Inability to concentrate or make decisions
Intense feelings of guilt and self-blame
Major changes in sleep patterns
Repetitive thoughts of suicide
Striking changes in appetite or weight (an increase or decrease)
Very low sense of personal worth
With major depressive disorders, these symptoms occur almost every day over a period of at least two weeks or more. Major depressive disorders vary greatly in terms of severity. However, even mild cases of major depressive disorder need treatment.
If you’re suffering from an episode of severe major depressive disorder, just how low you feel is difficult for someone who has never had the same experience to imagine. A severe, major episode of depression takes over a person’s life and slowly destroys all pleasure. But it does far more than wipe out joy; severe depression can make you feel that you are at the bottom of an unscalable pit of utter, unrelenting despair that stops you from showing and even feeling love. People caught in such a pit of depression lose the ability to care for themselves, others, and even life itself.
If you suffer from such a severe case of depression, there’s definitely good reason for hope. Many effective treatments work even with severe depression. So no matter how low and hopeless you feel – do get help. See Chapter 4 for the whole range available.
The daily pain of living begins the moment Edward’s alarm wakes him. He spends most of th
e night tossing and turning. He only falls asleep for what feels like just a few moments, before waking up to another day of despair. He forces himself to get ready for work, but the thought of speaking to others feels overwhelming. He can’t face the prospect. He knows that he should at least phone in sick, but can’t seem to raise his hand, or find the will to pick up the phone. He realises that he could lose his job, but it doesn’t seem to matter. He thinks that he has no future, and that he’ll soon be dead, so what does it matter anyway?
Slowly, Edward starts to get dressed, but then at the last moment he changes out of his work clothes, into a track suit, and then goes back to bed. But sleep won’t come. His mind fills with thoughts of self-hatred – ‘I’m a failure. I’m just useless. There’s nothing to live for.’ He wrestles with the thought that he should just end it now. Edward suffers from a major depressive disorder.
Major depressive disorders can significantly reduce your ability to function at work or deal with other people. Such disorders deprive you of the very resources you need for recovery. That’s why getting help is so important. If you allow the major depressive disorder to continue, it may result in death from suicide. If you or someone you know even suspects the presence of a major depressive disorder, you need to seek help promptly. Go to Chapter 4 for information on how to find professional help for depression.
Dysthymic disorder: Chronic, low-level depression
Dysthymic disorder, or dysthymia, is similar to major depressive disorder (see the previous section). However, dysthymic disorder is less severe, tends to be chronic, and persists for longer periods of time. With dysthymic disorder, the symptoms occur for at least two years (though often for far longer), with the depressed mood obvious on most days for the majority of each day. However, you only need to display two of the following chronic symptoms, as well as a depressed mood, in order for your condition to qualify as a dysthymic disorder:
Guilty feelings
Low sense of personal worth
Poor concentration
Problems making decisions
Thoughts of death or suicide
Compared with major depressive disorder, dysthymic disorder displays fewer physical symptoms such as problems with appetite, weight, sleep, and agitation.
Dysthymic disorder frequently begins in childhood, adolescence, or young adulthood and can easily continue for many years if left untreated. Also, people with dysthymic disorder are at an increased risk of developing a major depressive disorder at some point in their lives.
Major Depression - Understanding psychosis
Psychosis can be one of the serious symptoms of a major depressive disorder. Psychosis is diagnosed when a person is out of touch with reality. People with depression sometimes become so ill that they experience psychotic symptoms:
Delusions: These are plainly evident false beliefs, such as thinking the TV is transmitting signals to your brain.
Hallucinations: This is when you hear voices or see things that aren’t really there.
Paranoid thinking: This involves feeling extremely suspicious and distrustful, such as believing that other people are out to get you, or that someone is trying to poison you.
In most cases, depression with psychosis requires hospitalisation.
People with severe depression also may exhibit paranoid or delusional thinking. Paranoid thinking involves feeling extremely suspicious and distrustful – such as believing that other people are out to get you or that someone is trying to poison you. Delusions range from the slightly odd to bizarre, but they involve obviously false beliefs such as thinking the television is transmitting signals to your brain. The problems of psychosis need professional attention and lie outside of the scope of this book. However, we do detail medications commonly prescribed for these symptoms in Chapter 15.
Although someone with dysthymic disorder generally isn’t as devastatingly despondent as a person with a major depressive disorder, they are frequently lacking in energy and the joy of living. A person suffering from dysthymic disorder isn’t always easy to identify, but they are noticeable for being pessimistic, cynical, and grouchy a good deal of the time.
Caroline doesn’t remember ever feeling joy. She’s not even sure what the word means. Her parents worked long hours and seemed cold and distant. Caroline studied hard in school. She hoped to win approval and attention for her academic accomplishments. Her parents didn’t seem to notice.
Today, Caroline leads a life that’s envied by her colleagues. She earns a great salary and is a workaholic within her profession as a mechanical engineer. Yet she senses that she’s missing something, feels unsuccessful, and suffers a chronic, uneasy discontent. Caroline has a dysthymic disorder, although she wouldn’t actually say that she’s depressed. She doesn’t seek help for her problem because she actually has no idea that life can be different.
People with dysthymic disorder often see their problems as merely ‘just the way they are’, and so don’t look for treatment. If you suspect that you or someone you care about has dysthymic disorder, get help. You have the right to feel better than you do, and the long-lasting nature of the problem means that it isn’t likely to go away on its own. Besides, you certainly don’t want to risk developing a major depressive disorder, which is even more debilitating.
Adjustment disorder with depressed mood: Reactive depression
Life’s road isn’t always easy. You have to expect the rough with the smooth. Most of the time, people handle their problems without extreme emotional upset. At other times, they don’t.
Adjustment disorders are reactions to one or more difficult issues, such as marital problems, financial setbacks, conflict with colleagues, and traumatic events including natural disasters. When a stressful event occurs and your reaction lessens your ability to work or participate effectively with others, in combination with symptoms such as a low mood, crying spells, and feelings of worthlessness or hopelessness, you may be experiencing an adjustment disorder with a depressed mood. Adjustment disorder is a much milder problem than a major depressive disorder, but it can still disrupt your life.
Jim is shocked when his boss tells him that he’s being made redundant because of restructuring. He starts job hunting but posts in his field are scarce. For the first two weeks, he enjoys catching up on sleep, but soon he starts feeling unusually low. He struggles to open the newspaper to look for work, and stops checking the job websites. Jim begins to feel worthless and loses hope of ever finding a job. His appetite and sleep are still okay, but his confidence plummets. He’s surprised when tears stream down his face after receiving another notification that he hasn’t made the short list for a job.
Jim isn’t suffering from a major depressive disorder. Jim is struggling with what is known as an adjustment disorder with depressed mood.
People suffering from an adjustment disorder with depressed mood quite often don’t seek treatment. They assume if they wait long enough, the problem will just go away by itself. However, if you suspect that you or someone you care about has this problem, do get help. Otherwise you may still have difficulties long after the original triggering problem is resolved, and these can become a major problem for you and those around you.
Bipolar disorder: Ups and downs
Bipolar disorder is a mood disorder, just like other forms of depression. However, bipolar disorder is quite different from other types of depression because people with a bipolar disorder can experience episodes of irrational ‘highs’, called mania.
In bipolar disorder, moods fluctuate between extreme highs and lows. This makes the treatment of bipolar disorder different from other types of depression. We want you to be familiar with the symptoms so that you can seek professional help if you experience manic episodes within your depression. Self-help isn’t sufficient for the treatment of bipolar disorder.
Although individuals with mania may seem quite cheerful and happy, the people who know them can tell that their good mood is a little too good to be true. During mani
c episodes, people feel they need less sleep, may show signs of unusual creativity, and have loads more energy and enthusiasm. Sounds pretty good, doesn’t it? Who wouldn’t want to feel wonderful and totally on top of the world? Well, just hold your horses . . .
The problem with manic episodes related to bipolar disorder is that the ‘highs’ increase to a level where the person loses touch with reality. During manic episodes, sound judgement goes out the window. People who have bipolar disorder disorder often: